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Intake &Approval Sheet 'FOR PERMIT STAFF ONLY) PERMIT# Zia 9- 0010 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: if Assign To: Jess Date: 7//3 h.3 <br /> Intake Comments: Intake Comments: <br /> Zone <br /> Overlay/Agreement MFT£c-AbO1' stc eel <br /> ❑ Route to Commercial BuildingNonresidential Use sates <br /> obite, light truck or R�! <br /> sates or e'er►ton <br /> ❑ Route to Residential Building Residential Use N/A <br /> ❑ Make this a"W" Permit Proposed No. of Dwelling Units: N/A <br /> Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: N/A <br /> Garage/Accessory Struct.Size Planning/Landscape Inspection Required before Final? ❑Yes ONo <br /> Number of Stories "In Lieu" Fee:Type: Amount <br /> Basement ❑No ❑Yes , Fin/Unfin School Impact Fee: Total $0 <br /> Type of Construction Calculated: Credit: <br /> Occupancy Group DEverett School Dist ❑Mukilteo School Dist <br /> Occupancy Load Park Impact Fees for permits applied for after 1/1/2022: <br /> Fire Sprinklers: El Update Existing El New System ❑Not Req'd Park Impact Fee Total$ 0 <br /> Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): <br /> Fire Alarm: ❑Update Existing El New System El Not Req'd Permit Technicians:Apply Credit Per EMC19.53.200 <br /> Reason Fire Alarm Required: 0 100%Credit-Issued 1/1/2022-9/2/2022 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No 0 50%Credit-Issued 9/3/2022-6/2/2023 <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No 0 0%Credit-Issued 6/3/2023 or later <br /> VALUATION CALCULATION: Total$ Additional Notes: <br /> Approved By:� Date: 7/zo/2:3 <br /> PUBLIC WORKS <br /> Additional Notes: Intake OK by: Date: <br /> Intake Comments: <br /> €iPW Worksheet Needed if:,,,..,,_,.......,...........................,......... <br /> I❑Sys Dev Eval DTraffic Mit Eval <br /> Approved By:1 r f f p 1i4 Date: 7/7(4i/7j3 I DSite Work or Drainage Proposed <br /> OBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT supportive housing) <br /> Separate/Deferred Submittals Required: ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: _ ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> This Permit is Approved by Public Works <br /> Fire Dept. Fees: ❑ See PW Review Worksheet and associated attached items <br /> ❑ Review of As-Built Plans-NO FIRE FEE ❑ A Separate PW Permit is Required(Permit#: PW <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Approved By: Date: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ Public Works has no scope--- PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By:ar.^-..,9 -- Date: GG 43 / 'IA .3 <br />